Insurance Specialist

Overview

Position Summary The Insurance Specialist is responsible for the verification/documentation of insurance benefits, securing pre-certification/referral numbers and estimating/collecting patient liabilities on all outpatient scheduled procedures.

Lourdes Hospital

• Job Title:
  
  Insurance Specialist
• Job Type: Full time Monday - Friday
• Wage Range: $
• Reports to:
  
  Patient Access Supervisor
• FSLA:
  Non-exempt

• Ensures that pre-certifications required by managed care companies for scheduled surgeries and procedures are obtained on a timely basis and documented in advance of appointment
• Notifies physician offices and centralized scheduling in the event pre-cert is not obtained in time for patient appointment
• Heavy phone and payer website contact in accordance with payer pre-certification and verification regulations
• Communicates with insurance payers regarding any CPT code discrepancies or changes made due to radiologist discretion
• Performs insurance verification, eligibility and pre-certification for outpatient scheduled procedures
• Maintains current knowledge of outpatient imaging policies and procedures
• Verifies the patient has active insurance coverage and obtains insurance benefits utilizing insurance eligibility tools, payer websites and payer phone systems
• Communicates with Benefits and Notification Specialist whenever a patient has no verifiable insurance benefits to cover a scheduled procedure
• Works closely with physician offices and hospital departments when obtaining clinical information, providing them with necessary information or forwarding relevant documents
• Creates and explains patient liability estimate for all scheduled and add-on procedures
• Contacts patient or physician offices when insurance information is invalid or terminated for all scheduled procedures
• Provides registration functions, as needed
• Performs other duties as assigned

• High school diploma or equivalent – Required
• Two years of college or medical office specialist education – Preferred
• Working knowledge of managed care and third party payors
• One year experience with obtaining and verifying pre-certifications with various insurance companies – Required
• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
• Must be able to function appropriately in a multi-task setting

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

• Comprehensive Benefits:
  Multiple levels of medical, dental and vision coverage for full-time and part-time employees
• Financial Protection & PTO:
  Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and a minimum of 10 days of paid time off per year (for full time employees) as well as 8 paid holidays per year
• Financial & Career Growth:
  Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match
• Employee Well-being:
  Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs)
• Professional Development:
  Ongoing learning and career advancement opportunities

People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Lourdes Hospital, LLC, offers a lifetime of care across a broad spectrum of healthcare specialties and services. In fact, we ve built what has become one of Eastern Washington s largest multi-specialty medical groups.

Positioned in the heart of Washington wine and agriculture country, the Tri-Cities area is known for a plethora of sunshine and four predominantly mild seasons. The three major rivers, multiple nearby mountain ranges, and beautiful sun-soaked valleys offer endless natural beauty and year-round outdoor recreational opportunities.

Lourdes Hospital, LLC is committed to providing Equal Employment Opportunities for all applicants and…